Alcohol, Headaches and Hangovers

Dec. 26, 2006

By JOEL SAPER, M.D.

The spirits in a bottle can quickly ruin the spirit of a holiday. Some people just drink too much, and some people drink only a bit but pay a heavy price. For 35 years, I have encountered people with big headaches and little headaches, simple headaches and serious headaches, once-a-year headaches and daily headaches.

I have met people whose headaches result from just the smell of a beer and others whose headaches occur only after drinking a case of beer.

Here is some new information and some tips to help you take the spirits out of the bottle without taking the spirit out of the holidays.

Headaches From the Bottle

There are two major kinds of headaches that might appear after a night -- or afternoon -- of drinking. The first I call the soon-after headache, which occurs within one to four hours of drinking some but not all alcoholic beverages.

The other type of headache is the morning-after headache that occurs several hours after drinking has ceased and is usually part of the hangover.

The Soon-After Headache

Most people who experience the soon-after headache have had headaches in the past, usually migraine or related headaches. These headaches are actually genetic -- the brain biology changes so that it overreacts to both internal (hormonal, for example) or external changes, such as a swig from the bottle.

Ironically, even though alcohol is the intoxicating substance in these beverages, it is not usually the source of the headache. Certain nonalcoholic ingredients are more likely to induce the headache attack than alcohol itself.

Since brands vary in the amounts and types of these ingredients, some drinks are more likely than others to produce the headache.

Curiously, I have treated several individuals who can drink one brand of beer without developing a headache but can't stand even a sip of any other brand. Many people can drink white wine without developing a headache but will invariably experience a severe headache when they drink red wine.
Surprisingly, -- because hard liquor is more alcoholic than wine or beer, some people can drink vodka or gin (the crystal clear, light liquors) without developing a headache but cannot drink red wine, beer or the amber-colored hard liquors (rum, and the ever-gentle tequila).

Why the Difference?

As for beer, the ratio of hops, barley, malt and other ingredients distinguishes one beer brand from another.

Hard liquor contains ingredients called cogeners -- which also cause headaches. Darker, amber-colored liquors contain more congeners than light-colored liquors, such as vodka and gin.

Recently, research has suggested that mixed drinks containing sugar substitutes, such as aspartame and saccharin, which may cause headaches in their own right, actually cause a more rapid rise in the level of alcohol in the blood after drinking. Therefore, beware of alcoholic beverages containing diet colas or diet tonics.

The Hangover and Its Headache

While the soon-after headache comes from nonalcoholic ingredients, the hangover comes directly from the effects of alcohol itself. The hangover occurs eight to 16 hours after drinking moderate to high amounts of alcohol, after all that alcohol is out of the bloodstream.

The key symptoms of a hangover include headache (usually a throbbing headache), nausea and diarrhea, extreme thirst and dehydration, and excessive fatigue.

In a recent study of college students, participants on average experienced five of 13 symptoms, with headache, extreme thirst and dehydration, and fatigue being the most common. A family history of alcohol abuse made the study participants more vulnerable to the most severe effects. Curiously, women generally had higher hangover scores than men did.

What You Can Do

Best advice -- don't drink.

Second best advice -- do the following:

Before drinking, hydrate with both clear water and sports drinks that contain sugar and important minerals and salts. Avoid too much plain water.

Before drinking, eat fat-containing foods and those with high carbohydrate content. These ingredients slow absorption of alcohol and other ingredients from the stomach.

Avoid sugar supplements that increase the speed of alcohol absorption.

Drink slowly, sipping the drink, and minimize the amount of total intake.

For those who have the soon-after headaches, drink "headache-safe" beverages, such as white wine and crystal-clear, light liquor.

To prevent the effects of the hangover, if you can do so safely, take anti-inflammation agents, such as ibuprofen, naproxen or mefenamic acid before drinking.

If soon-after or hangover headaches do occur, treat them with anti-inflammatory agents (you must wait several hours if you took such an agent in advance of drinking) or an anti-migraine agent if you have them available.

Rehydrate with water and sports drinks. You must avoid narcotic-containing painkillers or any ingredient containing acetaminophen, most commonly known as Tylenol. Alcohol can make those drugs deadly.

These steps can help. Enjoy the holidays, but be smart and be careful.

Joel R. Saper, M.D., a board-certified neurologist, is founder and director of the Michigan Head-Pain and Neurological Institute in Ann Arbor, Mich., a private, international treatment and research center.